Industrial action by GPs could push more than a million extra cases to Accident and Emergency departments, health service modelling shows. 

The documents from NHS England come as GP practices across the country begin capping the number of patients they deal with each day, in protest over funding of their contracts.

Modelling drawn up by NHS England suggests the action could heap huge pressure on hospitals and pharmacies and cost more than half a billion pounds.

One scenario, based on GPs cutting activity by 30 per cent, suggests it could mean 1.2 million extra attendances at A&E departments and 1.8 million more calls to NHS 111 over the next four months.

Normally the NHS would expect around 9 million A&E attendances over four months. An extra 1.2 million cases over the next four months could mean the figure exceeds 10 million.

Speaking on a visit to Leeds Cancer Centre, Wes Streeting, the Health Secretary, urged family doctors to abandon work-to-rule measures, saying their action was “unnecessary”.

He said: “The risk with this collective action is that it’s not the Conservatives that are punished for their failure, it’s patients and other parts of the NHS [that] will be picking up the pieces.

“I urge GPs to work with the Government to rebuild general practice.”

The action follows a vote by the British Medical Association (BMA) which said it could continue for months.

In addition, the action could see nearly 2 million more pharmacy visits, almost 500,000 cases undergoing hospital treatment, and more than 700,000 people turning up at urgent care centres.

Meeting this demand could cost the health service £569 million, according to the modelling seen by Health Service Journal.

Research suggests that a GP appointment costs the taxpayer around £40 per visit, while a visit to A&E can incur a cost of around £400.

Mr Streeting has vowed to “fix the front door” of the NHS, saying that treating patients sooner, before they deteriorate, saved money as well as lives.

Even if the action only cut activity by 10 per cent, it could mean almost 400,000 more A&E cases, and almost 250,000 extra hospital referrals, it suggests.

The BMA has said doctors can “pick and choose” from measures designed to wreak chaos across the health service and bring the NHS “to a standstill”. They include a cap on the number of appointments, meaning practices could turn away record numbers of patients, heaping pressures on 111 and A&E.

Family doctors are being asked to cap the number of daily “patient contacts” – which includes face-to-face appointments, remote consultations and messages – at 25 per GP. This is a third less than the normal workload.

Health chiefs have already warned that such a move could prove “catastrophic”.

Other measures include refusing to cooperate with standard NHS systems, such as those used to refer patients to hospital specialists, or to share data with local health planners.

Last week, the BMA announced that GPs had voted overwhelmingly in favour of industrial action, with immediate effect. The union said 98.3 per cent of the 8,500 GPs voting backed the measures.

It says it has embarked on collective action because they say the current system is underfunded. The impact of the measures would be a “slow burn” not a “big bang” as different surgeries will embark on different actions, the union added.

But the Department of Health and Social Care said GPs had been balloted at the point when the GP contract was due to rise by 1.9 per cent, saying the pay uplift for 2024/25 would now be rising by 6 per cent.

Mr Streeting said other parts of the NHS were being left to “pick up the pieces” as a result of collective action by family doctors.

He said GP services had been “driven into the ground” by the previous government. But he added that Labour had shown “serious intent” to address the issues faced by family doctors.

Mr Streeting said that he wanted to see an end to industrial action by GPs as he called for a “serious professional partnership” between family doctors and the Government.

An NHS spokesperson said: “The NHS has to plan for any contingencies to ensure services continue to be delivered and patients are kept safe.

“As collective action has only just started, it’s not clear yet what the system-wide impact is and we are monitoring the situation closely, including working with ICBs to undertake modelling, which will be updated once we have confirmed information.”

“We are continuing to work with GPs, the BMA and the Government to resolve and end the action.”

Dr Katie Bramall-Stainer, chairman of the BMA’s GP committee, said: “It’s not clear how NHS England has calculated these figures, but if they are accurate, £569 million would go an awfully long way to reverse years of funding erosion in the GP contract, which currently stands at £659 million.

“It’s common sense that any projected cost associated with GPs taking collective action could be far better spent – putting it into our services to begin with.

“Not only would that eliminate the need for any action, but also give GPs the means to provide high-quality care for their patients. Underinvestment in essential general practice services has got so bad that practices get just 30p a day for every patient that’s registered with them – not even the price of an apple.

“Because of this, practices can’t give the standard of services they would like to; patients are waiting far too long for an appointment, we can’t afford to hire the staff we need, and many surgeries have been forced to close entirely.”

A TikTok fan who stabbed a British Army veteran to death for letting her white Pomeranian pet out continues to find the murder “amusing”, a court heard as she was jailed for 23 years.

“Malevolent” Winter Swan-Miller sought “revenge” on 62-year-old Stuart Crocker by stabbing him 27 times and strangling him with a handbag strap because he let her therapy pet, Oblivion, escape.

After murdering the grandfather, the 37-year-old took to TikTok and addressed thieves saying “taking my dog from me, the only thing in the entire world that I’ve got”, and boasted of how she had been a “bad girl”.

She had “malign intent” when attacking Mr Crocker, who suffered post-traumatic stress disorder from his time in the Army, and on Tuesday a judge condemned the “highly manipulative” individual for her ”merciless” attack.

“If fame and notoriety was your goal, then by killing Stuart Crocker in the appalling manner you did, you succeeded in achieving it for all the wrong reasons,” Judge Angela Morris said.

Opening the trial at Winchester Crown Court, Hants, in May, Nicola Shannon KC said Mr Crocker was found dead by paramedics at his home in Andover, Wilts, on June 28 last year.

His body was found under a white blanket with the TV playing and a switched-on fan placed behind his head.

Police believed Mr Crocker was stabbed some five days before and his body was “surrounded by notes” written by Swan-Miller.

One note read: “Take my f—–g dog you whore. This is why I’ve done this haha. How does his death feel haha. You thought I would let you get away with taking me for a f—–g mug. Taking my dog, are you real.”

Jurors were also shown a number of TikTok videos, organised into parts, which were posted on June 23.

In one video, titled “Part Two”, Swan-Miller can be heard saying: “Taking my dog from me, the only thing in the entire world that I’ve got.

“I did do what I did and I did it because I had no choice. They took away the only thing in my life that I have got, and that’s my dog Oblivion.”

The prosecutor said Swan-Miller hoped for “some degree of fame and notoriety for what she had done”.

After going on the run to Birmingham, she was eventually arrested on June 30 and remained in custody ever since.

This week, after a 12-week trial, a jury unanimously found Swan-Miller guilty of murder.

At her sentencing on Tuesday, Ms Shannon said Swan-Miller had an “intended desire for revenge” regarding “the treatment of her dog”.

‘Malevolent entity’

The prosecutor added: “Significantly, there has been no indication of remorse or acceptance of responsibility after the killing and indeed, multiple instances where Swan-Miller seems to find it amusing.

The prosecutor said there was a “deprivation of dignity” in the way in which Mr Crocker was killed and said Swan-Miller intended to “scare, harm and humiliate” him.

The court heard a statement from Joseph Kingswell, Mr Crocker’s son, who said his dad suffered PTSD from serving in the Army during the Northern Ireland Troubles.

The son described Swan-Miller as a “malevolent entity” and said his children are “no longer able to feel the warmth of [their grandfather’s] love”.

He added: “My family has been splintered. I wasn’t even able to say goodbye to him.”

Gurdeep Garcha KC, mitigating, said: “She has heard the sentence expressed and will have to come to terms with what she has done.”

Sentencing Swan-Miller, Judge Morris said: “[Mr Crocker] was someone who previously had dependency issues with both alcohol and drugs caused by his PTSD that he suffered from his time in the Army.

“Having heard the evidence in this case, I am satisfied that your relationship with Stuart Crocker was anything but exclusive and that you came and went from his presence as you pleased.”

‘Merciless and remorseless’

The judge said the relationship was “more of a convenience to you than anything born out of coercion from him”.

“If there was any level of control and coercion, that came much more from you to him than the other way around,” she added.

On the Pomeranian, the judge said: “You had a fixation on Stuart Crocker being responsible for allowing your dog to escape his flat. Your attack on him had an element of revenge in it.”

On the attack, she said: “It was orchestrated in a forceful and aggressive way against a defenceless man.”

Judge Morris said Swan-Miller was a “highly manipulative person” and her actions were “merciless and remorseless”.

The judge sentenced her to 23 years in prison.

It started as a gathering to protect a mosque from a rumoured far-Right demonstration on Monday.

But the initially peaceful gathering in Bordesley Green, a suburb of Birmingham, soon turned violent, ending in an attack on a pub and leaving one pubgoer with a “lacerated liver”.

Sean McDonagh, 51, was punched and kicked outside the Clumsy Swan pub after dozens of men, some carrying Palestinian flags, broke off from the main group.

Footage on social media shows him being punched by a man dressed in a black puffer jacket and balaclava in the pub’s front garden. He told The Telegraph that he was taken to hospital after the attack, and that he rejected a subsequent apology from the Muslim community.

Muslim men wearing masks and hoods first gathered outside the Village Islamic Centre mosque in Bordesley Green at around 5pm on Monday.

The crowd, some of whom were waving Palestinian flags and chanting “Allahu Akbar”, had turned out following rumours that far-Right demonstrators planned to descend on the neighbourhood that evening.

After six days of riots across the UK, during which mosques had been targeted, the young men had gathered in force. One was seen to be wielding what appeared to be a large bat.

As the evening progressed, it became clear the reports were inaccurate, and no far-Right mob appeared. But the gathering soon turned into a violent romp through the city’s streets.

In a clip that captured the chaos, a Sky News live broadcast was interrupted by a masked man who sped up behind the journalist Becky Johnson on a motorbike and shouted: “Yo, free Palestine, f— the EDL.” 

The broadcast was quickly ended and security sent to the reporter, according to Sky News. The broadcaster said a man in a balaclava stabbed the tyre of one of its broadcast vans, but did not damage it.

Later, people moved away from the mosque and walked further east. Footage posted online at 8.47pm showed chaos in Alcombe Grove, Stechford, around a mile and a half from it. A blue Skoda was being driven through a crowd of rioters, who attacked the vehicle and smashed its windows.

It is unclear who the driver was, or why his car became the target of an attack, but the anger and violence of the rioters was not in doubt.

In the late evening, the mob moved south down Stoney Lane, towards the Clumsy Swan pub where customers were enjoying an evening of karaoke.

It was here that Mr McDonagh was attacked by several men. 

Footage shows the masked man in the black puffer jacket entering the pub’s front garden and swinging a punch at him. As he falls to the floor, another rioter kicks him in the head.

Linda Fogarty, the pub’s 60-year-old assistant manager, could only watch from inside. She had got word that the mob was making its way towards the pub, and had barricaded the rest of her customers indoors, stacking chairs and tables against the front door.

She told The Telegraph: “I got everyone in, got the chairs in, got the customers in, staff in, locked the doors. And then it just escalated from there, they tried to kick the door in, smashed all the windows … It wasn’t great.”

Footage from inside the pub shows terrified drinkers looking out as rioters swarmed around the building and hurled missiles at it.

Friends Gabrielle O’Toole, 51 and Victoria Jones, 42, had been at the pub before the mob arrived. Speaking on Tuesday, they said it was “rubbish” that police intervened.

Ms O’Toole said: “I was there from the beginning. I can tell you that there was one police wagon parked at McDonald’s and not one policeman got out while I was there. It’s two-tier policing.

“When I was up there, I actually felt sorry for the police because they do not stand a chance. Racism is what it turned into. It’s absolute rubbish, they are petrified, they are outnumbered and they know they can do nothing. It was carnage up there.”

On Tuesday, Muslim community activists led by Naveed Sadiq, who was not involved in the riot, visited the pub and apologised for the violent scenes that had unfolded.

On Tuesday evening, West Midlands Police confirmed that an assault on a drinker outside the Clumsy Swan was being investigated as a violent disorder.

In a statement, the force also said a 46-year-old male had been arrested by police investigating TV footage that shows a man apparently armed with a weapon.

Other inquiries into damage caused to windows at the pub, attempts to slash a tyre on a Sky News vehicle, and damage caused to a Skoda car forced to drive across a grassed area after being attacked are under way.

What happened also caught the attention of Elon Musk, the owner of X, formerly Twitter, who has provoked a row with Downing Street over how widespread riots are being policed across the UK.

Mr Musk branded the Prime Minister “two-tier Keir” in a comment on X in response to a video showing the mob attacking the pub. He captioned video footage: “Why aren’t all communities protected in Britain?”

A company director sobbed in court on Tuesday, dabbing his eyes with a handkerchief, as he was told he would be remanded in custody for his alleged part in rioting in Middlesbrough on Sunday.

Joe MacKenzie, 28, is accused of being among a main body of around 20 men wearing balaclavas and face coverings who clashed with the police during violent disorder in the city.

He is one of 28 people to have appeared at Teesside magistrates’ court on Tuesday in connection with the disorder.

Those who appeared in court are aged between 16 and 56.

Twenty-six are charged with violent disorder, one adult aged 18 is charged with possession of an offensive weapon and another, aged 32, was charged after being wanted on warrant.

A total of 40 arrests have now been made in connection with the disorder in Middlesbrough.

Four adults have been released on bail pending further enquiries, one remains in hospital because of a pre-existing medical condition and seven juveniles were released on bail while enquiries continue.

Mr MacKenzie, from Darlington, began to weep while sitting alongside a dock officer as Chris Tame, prosecuting, briefly outlined the case against him.

Mr Tame said: “The defendant was arrested on suspicion of throwing items, attacking police throughout the day and shouting expletives. He was seen drinking from a can of lager.”

Defendant denies using or threatening unlawful violence

Mr MacKenzie, a director in his father’s kitchen and bathroom business, denies using or threatening unlawful violence and will face trial before Teesside Crown Court on a date to be fixed.

Nick Woodhouse applied for bail on Mr MacKenzie’s behalf, claiming that he had gone into the centre of Middlesbrough “out of curiosity.”

Mr Woodhouse told the court: “Mr MacKenzie was attempting to leave the centre of town and go back to his car but found his way blocked by a police cordon.

“He was told he would have to walk around two miles back to his vehicle, which would have been made difficult as he suffers from a club foot.”

Mr Woodhouse added that Mr MacKenzie was concerned his family business would fold if he spent further time in jail awaiting trial, but he was remanded in custody.

Also appearing at court was Thomas Rogers, 22, of no fixed address, who hurled rocks at police and yelled: “I hope your kids get raped.”

Mr Rogers was remanded in custody awaiting sentence after he admitted being in possession of an offensive weapon – the rocks – and using or threatening unlawful violence.

The court heard he was in a group of 30 people pelting police during the rioting on Sunday.

He later told officers: “I’m glad I threw the rocks.”

Teen accused of carrying axe 

A 16-year-old, who cannot be named for legal reasons, is accused of carrying an axe during the mayhem. He is charged with unlawful violence and carrying an offensive weapon.

He spoke in court to confirm his date of birth and address. He was accompanied by a dock officer.

He pleaded not guilty to the weapon offence but did not enter a plea to the other charge.

Andrew Livingston, 53, from Clifton Street, Middlesbrough, denied violent disorder and made no plea to a further charge of possessing a 46cm bladed article.

Shaven-headed Mr Livingston, heavily tattooed and wearing a white vest, looked to the ceiling as he was told he would be remanded in custody until Aug 27 when he will appear again before Teesside Crown Court.

District Judge Marie Mallon remanded him in custody while warning people talking in the public gallery they would be removed if they continued to cause disruption.

Connor Stokes, 26, of Thornaby, Teesside, denied unlawful violence and was remanded in custody after the court heard he was a “main participant” in the disorder.

Mr Tame told the court Mr Stokes, who had been wearing a grey tracksuit and black face covering, had been identified by police as one of a group of protestors hurling rocks.

Mr Stokes called “see you in a bit” to his family as he was remanded in custody by District Judge Helen Cousins.

Possession of offensive weapons

Ethan Bowes, 18, blew a kiss to his mother and father as he faced charges of violent disorder and possession of offensive weapons.

The defendant, from Guisborough, North Yorkshire, pleaded not guilty to possessing a sharp rock, possession of a sock “containing a heavy object” and violent disorder.

The teen, dressed in a black Nike T-shirt, was told he would be remanded in custody. Judge Mallon said: “These offences are too serious to be held in this court and must be heard at the crown court.”

She told the defendant he must appear on Aug 27 for a preliminary hearing.

Ashley Ferguson, 33, of Somerset Street, Middlesbrough, is alleged to have waved a pole towards police “in a threatening manner”.

Mr Ferguson pleaded not guilty to violent disorder and possessing an offensive weapon and was remanded in custody until Aug 27 when he will appear at a crown court.

Jamie Bullock, 20, appeared before the court accused of having a hand in an incident in which a burning wheelie bin was pushed at police.

He was said to have been involved in the incident, with prosecutor John Garside telling the court the accused had “visited the location wearing gloves and a balaclava”.

Mr Bullock, of Berwick Hills Avenue, Middlesbrough, pleaded not guilty to violent disorder.

The court heard he “maintains he did nothing wrong at all – he was offered a lift in a van home”.

He was remanded in custody until his next appearance at crown court on Aug 27.

Police ‘resorted to using leg restraints’

Jamie Govan, 26, who allegedly shouted profanities and kicked out at police during the disorder in Middlesbrough, was also remanded in custody. He denied a charge of violent disorder.

Mr Garside said Mr Govan is accused of shouting: “‘You’re protecting them while they rape and kill kids”, at officers before making “come-on gestures with his hands”.

The court heard he allegedly swung his arms and kicked his legs out at police who “resorted to using leg restraints”.

Mr Govan “maintains he did nothing wrong”, a district judge was told.

The defendant was remanded in custody until his next court appearance on Aug 27.

Lewis Loughlin, 23, of Middlesbrough, was remanded in custody after denying using or threatening unlawful violence in the town’s rioting.

Mr Tame said Mr Loughlin was stopped in a green car which appeared to be involved in the disorder.

Inside they found an empty petrol can, a baseball bat, knives and tools.

Mr Loughlin claimed he was simply “in the wrong place at the wrong time” and had nothing to do with the violence.

He was remanded in custody by Judge Cousins until his next appearance on Aug 27.